Provider Demographics
NPI:1154868412
Name:CALHOUN, KYLE WINTERS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:WINTERS
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7160
Mailing Address - Country:US
Mailing Address - Phone:770-330-3195
Mailing Address - Fax:
Practice Address - Street 1:202 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7160
Practice Address - Country:US
Practice Address - Phone:770-330-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221514367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered